In a U.S. population-based study reported in the Journal of Clinical Oncology, Cohen et al found that Black patients had the lowest incidence of cervical adenocarcinoma—but the poorest related 5-year survival and overall mortality—compared to patients with cervical adenocarcinoma in other racial/ethnic groups.
Study Details
The study assessed age-adjusted incidence rates among cervical cancer cases diagnosed between 2000 and 2018 using the Surveillance, Epidemiology, and End Results (SEER) 21 registry, and incidence-based cervical cancer mortality rates among deaths from 2005 to 2018 using the SEER 18 registry. Incidence and mortality rates were corrected for hysterectomy prevalence using data from the Behavioral Risk Factor Surveillance System.
Key Findings
Of 75,422 eligible cases included in the analysis, 54,023 (71.6%) were classified as squamous cell carcinoma, 16,447 (21.8%) as adenocarcinoma, 2,963 (3.9%) as adenosquamous carcinoma, and 1,989 (2.6%) as other.
Corrected incidence rates of cervical squamous cell carcinoma were highest in Black (13.8 cases/100,000 person-years) and Hispanic patients (11.8/100,000 person-years).
Corrected incidence rates of cervical adenocarcinoma were highest among Hispanic (3.0/100,000 person-years) and White patients (2.5/100,000 person-years), particularly for localized adenocarcinoma (1.5 and 1.2/100,000 person-years, respectively). The incidence rate was lowest among Black patients (2.0/100,000 person-years).
Squamous cell carcinoma incidence rates were higher with lower county-level income and education levels in all racial/ethnic groups, whereas incidence rates for adenocarcinoma did not vary substantially according to these factors for most racial/ethnic groups.
For both histologic subtypes at every stage, Black patients had the lowest corrected 5-year relative survival, whereas Hispanic patients generally had the highest survival irrespective of subtype and stage. For example, 5-year relative survival was 61.1% and 53.3% for all squamous cell carcinoma and all adenocarcinoma among Black patients. Compared with White and Hispanic patients, Black patients had lower 5-year relative survival for regional adenocarcinoma (37.6% vs 61.5% and 65.1%, respectively) and distant adenocarcinoma (9.2% vs 21.1% and 24.9%, respectively). Differences in corresponding survival rates for squamous cell carcinoma were much less marked.
Black patients had the highest corrected overall mortality per 100,000 person-years for squamous cell carcinoma (4.0 vs 2.9 for Hispanic and 1.9 for White patients). Despite having the lowest incidence of adenocarcinoma, Black patients also had the highest overall mortality per 100,000 person-years for adenocarcinoma (0.6 vs 0.5 for Hispanic and 0.4 for White patients).
The investigators concluded, “Although Black [patients] are less likely to be diagnosed with adenocarcinoma compared with all other racial/ethnic groups, they experience the highest mortality rates for this subtype, likely attributed to the poor survival observed for Black [patients] with regional and distant adenocarcinoma.”
Camryn M. Cohen, BS, of the Clinical Genetics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Intramural Research Program of the National Institutes of Health and the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
